Stricturing subocclusive small bowel Crohn's disease (CD) is often an indication for surgery. We embarked on an open label pilot study to assess the safety and efficacy of infliximab in patients with ... [more ▼]

Stricturing subocclusive small bowel Crohn's disease (CD) is often an indication for surgery. We embarked on an open label pilot study to assess the safety and efficacy of infliximab in patients with stricturing subocclusive CD. Patients and methods : A cohort of patients with a documented and symptomatic small bowel stricture caused by CD was studied. Patients had to be refractory to corticosteroids and/or immunosuppressives, and not in need for immediate surgery. The patients were treated by a single infusion of infliximab 5 mg/kg and followed up at w1, w2, w4 and w8. Results : After the 6(th) patients, the study was prematurely discontinued because the predefined safety thresholds of more than 2 surgeries within the first 5 patients was reached. Only two patients completed the 8 weeks study, with a positive response to infliximab and improvement of inflammation confirmed by the CRP and CT scan. Two patients had to be operated early and the last two patients first did well but worsened after one month and were operated 35 and 42 days after infliximab, respectively. No surgical complications occurred in the 4 operated patients. In conclusion, a subset of patients with subocclusive small bowel stricturing CD may benefit from infliximab. [less ▲]

We report herein the case of a Belgian 76-year-oId woman who developed a hepatic tumour suspected to be a breast cancer metastasis. Radiological imaging and guided biopsies were not contributive. The ... [more ▼]

We report herein the case of a Belgian 76-year-oId woman who developed a hepatic tumour suspected to be a breast cancer metastasis. Radiological imaging and guided biopsies were not contributive. The patient underwent an explorative laparoscopy with frozen sections that did not provide further diagnosis, and an open left bisegmentectomy was performed during the same anaesthesia. Histopathological examination of the hepatic mass showed Echinococcus multilocularis metacestodes, demonstrating alveolar echinococcosis. As our patient denied any travel in foreign countries and has undergone regular abdominal ultrasonographies since her mastectomy, it is highly likely that this alveolar echinococcosis had been contracted in Belgium. If some imported cases may be seldom managed in Belgium, to our knowledge, this case is the first occurrence of alveolar echinococcosis contracted in Belgium. This report, added to the demonstration of E. multilocaris infection of 50% of red foxes in Southern Belgium, and the potential infection of domestic cats and dogs, should attract attention of the medical community on the possible outbreak of endemic alveolar echinococcosis in Belgium, and on the related public health concerns. [less ▲]

Focal xanthogranulomatous pyelonephritis is an unusual form of chronic renal infection that is difficult to diagnose prior to surgery. We report on a 19-year-old woman who presented with a renal mass that ... [more ▼]

Focal xanthogranulomatous pyelonephritis is an unusual form of chronic renal infection that is difficult to diagnose prior to surgery. We report on a 19-year-old woman who presented with a renal mass that mimicked malignancy. The diagnosis of focal xanthogranulomatous pyelonephritis was first suspected by radiological findings and further confirmed by histopathologic examination of percutaneous biopsy specimens of the lesion. Successful treatment of the patient was achieved with antibiotic therapy alone. Maximal efforts, including percutaneous renal biopsy, should be made to establish the diagnosis of focal xanthogranulomatous pyelonephritis before a therapeutic decision is reached. We recommend the use of antibiotics as a first-line treatment for patients with focal xanthogranulomatous pyelonephritis. [less ▲]

OBJECTIVE: Functional evaluation of digestive transplants after oesophagectomy for cancer. MATERIAL AND METHODS: We evaluated alimentary comfort and quality of life and performed a videofluoroscopy ... [more ▼]

OBJECTIVE: Functional evaluation of digestive transplants after oesophagectomy for cancer. MATERIAL AND METHODS: We evaluated alimentary comfort and quality of life and performed a videofluoroscopy (radiocinema) in 34 patients who were alive and disease-free one year or more after oesophagectomy for malignancy. There were 22 males and 12 females; mean age was 64 years. Twenty-three patients had a gastric pull-up and 11 a colonic graft. Mean follow-up was 36 months (range: 12-100 months). Possible correlations between clinical symptoms and radiographic observations were studied with Fisher's exact test. RESULTS: Most-cited symptoms were gurgling in 16 patients, early fullness during eating in 15, diarrhea in 14, postprandial sweating in 9, pyrosis in 8, nocturnal cough in 7, and dysphagia in 5. Most patients considered the side effects of the operation as mild to moderate and mean rating of alimentary comfort was 7.6/10. Twenty-five patients qualified their quality of life as good, 8 as satisfactory, and 1 as poor. Twenty-nine patients led active lives. Videofluoroscopic evaluation showed that colonic grafts emptied mainly by gravity, while active contractions were observed in the antrum of gastric transplants. There was a significant correlation between alimentary symptoms and radiographic distension of the transplant. Oro-pharyngeal abnormalities, site of proximal anastomosis, nature, motility, or active versus passive emptying of the transplant did not correlate with clinical complaints. CONCLUSIONS: In most patients quality of life and alimentary comfort are good after oesophagectomy and gastric or colonic interposition. Radiocinema is an adequate method to evaluate the dynamic of the transplant and shows a better emptying of gastric grafts, compared to colonic grafts, particularly when the proximal portion of the oesophagus triggers the progression. [less ▲]